Criteria:
(1) It may affect infants, children and adolescents from 1 to 16 years.
(2) The child should have a history lasting >= 12 weeks.
(3) Defecation occurs 0-1 time per week.
(4) The passed stools are large with a significant diameter.
(5) The child actively fights to not defecate. This may take the form of retentive posturing, purposeful contraction of the pelvic floor muscles, and squeezing of the gluteal muscles.
(6) The child may have episodes of fecal soiling if the efforts fail to retain the stool or if liquid stool leaks around the retained stool.
(7) Physical examination shows a large fecal mass in the rectum.
(8) The child may be afraid of painful defecations, ashamed of bodily functions and/or feel isolated.
Exclusions:
(1) occult spinal dysraphism
(2) Hirschsprung's disease
(3) disorder of the anal sphincter
